Diagnostic algorithm for precocious puberty, including malignancy as an underlying cause. AFP, alpha-fetoprotein; BHCG, beta-human chorionic gonadotropin; CAH, congenital adrenal hyperplasia; CNS, central nervous system; CPP, central precocious puberty; DHEA-S, dehydroepiandrosterone; E&M, evaluation and management; GnRH, gonadotropin–releasing hormone; H&P, history and physical examination; LH/FSH, luteinizing hormone and follicle stimulating hormone; MAS, McCune Albright syndrome; PP, precocious puberty.